Blepharitis

Question: My eyes sting and water a lot. Also, when I wake up in the morning, I have a lot of junk in my eyes. What’s going on and what can I do?

Answer: You may have a mild case of blepharitis! The term “blepharitis” may sound dangerous, but it is really nothing to worry about. It simply means that you have eyelid (bleph) inflammation (itis). Blepharitis is very common, and most of us have eyelid inflammation to some degree, though certainly some people seem to suffer more so than others. The hallmark symptoms of blepharitis are stinging and a “gritty” sensation to the eyes.

To understand how your eyes are affected with blepharitis, there are two things that occur along your eyelids. The first (and more straightforward explanation) is that debris forms at the base of the eyelashes. This buildup is composed of dry tear secretions and dead skin cells, and this buildup can actually foster the growth of skin bacteria that inflame the eyelids and cause discomfort. This eyelash debris can even fall into your tears and irritate the surface of the eye, making your eyes feel “gritty” or “sandy” . . . especially first thing in the morning.

The second problem that blepharitis causes is a clogging of the oil glands running along your inner eyelids (at the base of your eyelashes). The oil produced in these glands is important because it keeps your tears from evaporating too quickly. To explain this phenomenon, you can imagine that the smooth surface of your eye is like the driveway in front of your house, covered with a thin layer of water (perhaps after a rain or after washing your car). Because the water on your driveway is spread very thin, it evaporates quickly. However, if your car has an oil leak, the oil doesn’t evaporate off your driveway so fast … the oil is there for a very long time!

The oil produced along your eyelid margins serves a similar purpose, as this natural oil floats on the surface of your eyes and keeps your thin tear film from evaporating away. With blepharitis, however, the oil pores become clogged, and even though you seem to produce copious tears, the actual quality of those tears is poor and they tend to dissipate away. This causes further eye irritation!

There are several things you can do to treat blepharitis … both to remove the debris along your eyelashes, and to allow your natural oil glands to flow better. One simple method is to use a warm compress, such as a washcloth run under warm water. Once a day, lay this across your closed eyes to give yourself a little “eyelid sauna.” The warm water will help open up those oil gland pores. Some people find it helpful to add a dab of no-tears baby shampoo and massage their lids in the shower (eyes closed, of course). The combination of heat, a mild shampoo, and gentle massaging will really get those pores to open up! This will also clear off any debris that may be clinging to the base of your eyelashes.

Blepharitis is a chronic condition. It is not really an infection or a disease, but more akin to having oily skin or dandruff. The key is to come up with a regimen of lid hygiene that makes you comfortable. If your eye irritation persists, you should consider visiting an eye doctor. An eye doctor can look at your lashes and meibomian (oil) glands under the microscope and give you a more definitive diagnosis. Also, an eye doctor can prescribe a short trial of oral antibiotics or topical antibiotic ointment at night that helps many people suffering from blepharitis.

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